Varicocele: photos, symptoms, treatment, causes

Varicocele is a disease that affects about 40% of the male population. The disease is rather insidious, as it often does not have severe symptoms and is detected in preventive examinations.

Due to the fact that the onset of the disease manifests itself at a young age of 12-14 years, the young men are embarrassed or do not pay much attention to it.

It should be noted that the absence of treatment of the disease, leads to infertility in almost 25% of 40% of patients.

Varicocele is characterized by an increase in the caliber of the veins of the spermatic cord( varicose extension), manifested as nodules in the region of the groinlike plexus. This condition is caused by inadequate operation of the valve apparatus of the scrotal veins. And as a consequence, leads to a disruption in the nutrition of the testicles and spermatogenesis.

Symptoms of varicocele

In men, the degrees of classification and symptoms of varicocele are closely interrelated. In the initial stages of the presence of varicocele testicles can be suspected by such criteria:

1. - the first - the second - the disease has no pronounced manifestations. With an increase in the degree there is an insignificant weight in the scrotum, sometimes a mild aching pain. Patients note that the manifestation of the pain syndrome occurs due to a rise in severity or with an increase in intensive loads in general.
   
2. - the third - the fourth degree - appears edematous, change of color of a skin of a scrotum, its deformation is visually noted.

There are two types of varicocele - primary( idiopathic) and secondary( symptomatic), which develops as a result of changes in the shape( lower) of the hollow vein, as a result of the germination of tumors.


According to NA Lopatkin's classification, it is based on the manifestation of varicocele and changes in testicular trophism, distinguish only two degrees:

1. I degree - when visually you can determine the expansion of veins, with the testicle without pronounced changes;
   
2. II degree - pronounced changes in the testicle, its decrease with a change in consistency, aggravated dysplasia of the veins of the scrotum.

According to Yu. F.Isakov classification, which is more often used in children's practice, three degrees are distinguished:

1. 1 degree of - is not visually determined, palpatory with the patient's exertion or attempts;
   
2. 2 degree - and visually, and palpation can be identified nodular formations, while the trophicity( cellular nutrition) of the testicle is not detected;
   
3. 3 degree - varicose veins with a decrease in the testicle and a violation of its functions.

Some specialists distinguish the fourth( IV) degree, which is associated with changes in the vena cava, the manifestations are also associated with changes in innervation and blood supply to the testicles, which lead to atrophy of its tissues.

Causes of varicocele

Manifestations of varicocele are caused by a combination of factors, such as:

• physical activities( work associated with lifting weights, sports);
  
• vein thrombosis;
  
• is a kidney disease characterized by prolonged compression of the veins of the kidneys( narrowing of the left renal vein);
  
• valve valve apparatus defect;
  
• weakness of the vascular wall;
  
• tumors of the abdominal wall( compression of the vessels occurs)

In general, this is a series of diseases in which the intra-abdominal pressure increases or increases.

Diagnosis

Diagnosis of this disease begins with physical examination methods. Visually and palpatorially examining the patient, we can assume the degree of progression of the process.

1. 1) Clinical blood and urine tests in some cases will show microhematuria and proteinemia.
   
2. 2) Sperm analysis can vary from normal to azospermia( absence of sperm in seminal fluid).Patospermia is a violation of spermatogenesis, for varicocele it is quite an ordinary situation.
   
3. 3) The degree of vein dilatation of the groinlike plexus is determined, both at rest and under load, the volume of the testicles and their consistency.
   
4. 4) Currently, in the early stages of the survey, ultrasound and color Doppler ultrasound are more often used.
   
5. 5) Radioisotope methods are also effectively used - indirect isotope angiography, dynamic and nephroscintrography.

Treatment of varicocele

Varicocele treatment is conservative, with almost no positive results. The operative( surgical) method allows to eliminate the disease, is a preventive and cosmetic procedure.

Any kind of surgical intervention carries the main goal-the creation of venous anastomosis - an artificial way of venous blood outflow from the testicle.

Operative intervention is divided into three categories, depending on the access:

• open( traditional) operation;
  
• endovascular occlusion;
  
• endoscopic method.

There are about a hundred kinds of surgical treatment varicocele. Most surgeons prefer traditional methods of surgical intervention, such as:

• operation on Ivanisevich;
  
• operation for Palomo;
  
• operation for Bernardi;
  
• operation on Kondakov;
  
• operation for Palomo-Erokhin, etc.

All these operations in their technique are aimed at doping and crossing the branches of the testicle vein( testicular pathways).

Complications in the postoperative period are rare:

1. 1) Sometimes in the form of swelling, dropsy testicles.
   
2. 2) Even less often in the form of lymphostasis( stagnation of lymph in the tissues of the testicle).
   
3. 3) Thrombosis of the scrotal veins.

Very rare and relapse of the disease. Ligation of the ureter, lymphatic duct, spermatic cord, embolization of the latter is also a complication, which may appear due to technical oversight, but are rare.

It is very important to take a responsible approach to choosing an operative intervention. Given the significant progress in medicine in recent times, choosing an endoscopic or microsurgical method of surgery, you can get guarantees of virtually no relapse. Also, these methods practically exclude damage to the integrity of the testicle and seminal cord tissues, which in the future affects reproductive function.

Timely not taken measures to treat the disease can lead to infertility of men. Due to the violation of the functions of spermatogenesis, morphological indicators of the sperm and the endocrine system, infertility can become an irreversible process. Absence of treatment provokes an increase in pain, especially after physical exertion.

With regard to prevention - specific prevention simply does not exist. Patients with varicocele are not recommended to lift weights, we should wear tight swimming trunks, swim in the pool and do not waste time with surgical treatment. Also, do not engage in self-medication and treatment with folk methods, there is no conservative treatment for this disease.

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